Assessment of 2014 Medicaid MCO Quality Rankings Five Slide Series, Volume 16 September

Summary of Tabulations NCQA Medicaid MCO Quality Scores and Ratings were published online this month; available at We assessed Medicaid MCOs’ quality scores on several dimensions. Scores were assessed on both an unadjusted and adjusted basis 15% of NCQA scores are tied to whether MCO has attained NCQA certification (rather than statistical quality performance). Our adjusted scores on the ensuing tables give 12 additional points to non-certified plans in an effort to fairly compare statistical quality performance. MCOs accredited by NCQA on an interim basis received an additional 8 points in our adjusted scores. Average Medicaid MCO quality scores by state are shown on Slides #2 and #3 Nationwide, the non-publicly traded MCO average was slightly above the publicly traded MCO average (79.6 versus 78.0 using our adjusted scores) In the 19 states where both types of MCOs compete head-to-head (with at least one MCO of each type having a 2014 quality score), average scores were higher in the non-publicly traded MCOs in 11 states, and were higher in the publicly traded MCOs in 8 states. Top-performing MCOs relative to the average of remaining MCOs in same state are shown on Slide #4. Changes in quality scores from are assessed on Slide #5. We also note that quality scores are closely clustered outside of the top-scoring MCOs and the relatively lower-scoring MCOs. The score gap from the top-ranked MCO to the #20-ranked MCO was 4.8 points. The score gap for the next 80 MCOs (MCO #21 to MCO #100) was only 5.8 points. The gap from #101 to #120 was 7.2 points. 1

Medicaid MCO Average NCQA Quality Scores by State (highest-rated states shown on this slide) 2 MCO quality scores have always been relatively high in certain states (e.g., those at top of this table). Our March 2014 report, “Analyses of NCQA Quality Rankings Among Medicaid MCOs,” assesses this dynamic in detail.

Medicaid MCO Average NCQA Quality Scores by State (lowest-rated states shown on this slide) 3

Top-Performing Medicaid MCOs Relative to The Rest of State Average During The rest of state averages were calculated using each MCO’s adjusted NCQA score to compare statistical performance only. (Our adjusted scores do not factor in NCQA certification status.)

Changes in Medicaid MCO Quality Scores from Across the 118 Medicaid MCOs with a published score in both years, the average unadjusted score increased from 78.1 in 2013 to 78.5 in This is driven by several MCOs becoming accredited thereby receiving a significant score increase. Our adjusted scores are unaffected by accreditation changes; these show that the average score across the 118 MCOs decreased from 79.9 in 2013 to 79.2 in of the 118 MCOs (64%) had a lower score in 2014 than in 2013 (looking at unadjusted scores). In 2014 the average score gap between the publicly traded and non-publicly traded MCOs narrowed. The average score for publicly traded MCOs increased from 76.8 in 2013 to 77.9 in 2014, while the average for non-publicly traded MCOs decreased slightly from 79.3 in 2013 to 79.1 in The average score was 1.2 points higher across the non publicly traded MCOs in 2014 (versus a 2.5 point gap in 2013). NCQA “raises the bar” in several ways in calculating an ensuing year’s scores, thus a lower score versus the prior year cannot automatically be presumed to reflect a poorer statistical quality performance. 5

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